May 2009

Submitted by Jason Merchant, MD, and Mitchell S. Komaiko, MD.

History:

54 year old man with no significant past medical history presents with left lower quadrant pain since this morning. The only precipitating factor he can recall is tripping and falling forward while walking earlier in the morning. He braced his fall on outstretched arms, then lightly hit his chest and abdomen

Shown below are three non-contrast CT images through the abdomen at the level of the kidneys:

What is the next most appropriate imaging study to order?

• Renal ultrasound
  
• Intravenous urography
  
• Contrast CT with delayed images
  
• MRI
  
• Renal Nuclear Medicine Scan
  
• Angiography